Clinical Nurse Leader

A clinical nurse leader is a nurse in charge of coordinating and integrating patient care within a group of patients. It is a relatively new nursing role, and was created by the American Association of Colleges of Nursing as the result of investigations into methods of improving patient care and prepare student nurses for the future of the healthcare system. A clinical nurse leader is a registered nurse with a Master’s degree in the Science of Nursing. A CNL has also finished advanced nursing course work in a number of specialties, such as pharmacology, pathophysiology, and clinical assessment. A CNL has to have a grounding in many different strategies in order to be able to coordinate between them. In order to effectively carry out the analysis of patient care data, CNLs are also trained in statistics and data analysis, project design, and many other generalist skills.

A clinical nurse leader must constantly research the cutting edge of nursing practices, procedures, and technology, and find out what has been proven to work and what hasn’t. Using this knowledge the CNL must then bring the best of the new developments to his or her own facility. The CNL also must regularly study patients’ charts and progress, and evaluate which procedures are working and which are not. A CNL has the authority to make changes to patient care plans when necessary. The clinical nurse leader is also responsible for making sure that every patient’s health care plan is individualized to their particular needs. The CNL combines both extremes of the professional nursing world. These nurses are involved personally with each one of their patients on the one hand, and aware of the current state of the science and practice of nursing on the other.

He or she also serves as the contact point for a whole network of other professionals: doctors, social workers, pharmacists, and other nurses, and helps make sure that they are all working with the same information and to the same purposes. A CNL oversees patient medical teams. This kind of nurse is an advanced generalist, who combines the functions of traditional nurse, administrator, and professional researcher, and has a role in all health care settings, including nursing homes, hospitals, memory care centers, doctor’s offices, rehabilitation centers, and hospices.

Clinical nurse leaders are also responsible for reducing the occurrence of medical errors. Estimates of the number of American deaths due to medical errors place it at a minimum of 44,000 and maybe as much as 98,000 each year, to say nothing of suffering related to non-fatal errors. A major part of the clinical nurse leader’s purpose is to see both the big picture and the details of their practices, to make them run safely and more effectively. They are also supposed to provide greater accountability for patient healthcare outcomes. By taking charge of creating, evaluating, and coordinating patient care procedures, clinical nurse leaders also take responsibility for their patients.

The role of the CNL is actually just a formalization of a role that had developed organically. Executive nurses have testified before nursing task forces that this role had informally developed as a response to the needs of modern health care services, with the occupants of these roles trained for them on a personal, informal, and adhoc basis, and were recruited on the basis of previous job experience.

Although similar in some ways, a clinical nurse leader is not the same thing as an advanced practice registered nurse, a clinical nurse specialist, or a nurse practitioner. APRNs, CNSs, and NPs are all educated as specialists in a well-defined area of practice. A CNL, on the other hand, has a broader, more general education in different specialties. The CNL is more of a complementary role to these other nursing specialists. By working with each of these other types of nurses the clinical nurse leader ensures that patients benefit from specialist attention coordinated by the generalist perspective.

Clinical nurse leaders were never intended to replace nurses with baccalaureate degrees. The American Association of Colleges of Nursing is in no way recommending that baccalaureate nursing programs be phased out. Instead, it recognizes that while some circumstances call for post-graduate education in nursing, many other areas of the field are much better served by the graduates of traditional four-year nursing programs. However, a clinical nurse leader requires so much extra education that it would be impossible to have the needs of the position filled simply by modifying the existing four year programs.

There are a number of different ways to work up to a CNL certificate. Originally a BSN was required first. Today, however, ADN graduates can become trained as CNLs as well. MSN graduates can as well. No matter which of these places the training begins from, all end up producing the same CNL Master’s degree. The CNL program takes an average of four semesters to complete. The training is provided with high technology practical instruction, where students are exposed to the latest in nursing technology. Because the CNL training is so complex and advanced, CNL schools tend to be very selective when it comes to their applicants.

Family Nursing

Family nursing is a subgenre of medical care provided by Certified Nurse Practitioners (CNP). These are highly trained advanced practitioners of the nursing arts who have chosen to specialize in general care for children, adults and the elderly. CNPs hold either a graduate or doctoral degree in nursing and are qualified to diagnose and treat both physical and psychiatric infirmities. Family nursing is usually provided by a CNP who has pursued family medicine as a speciality. Other possible specialties include pediatrics, geriatrics, emergency nursing, occupational medicine, gynecological/ reproductive health and acute care.

Certified Nurse Practitioners

Although they are not physicians, nurse practitioners often function as the primary healthcare provider for many patients. Those who have obtained the Doctor of Nursing Practice (DNP) degree frequently run their own clinics, where patients receive family nursing services and, if necessary, referrals to other medical providers and health authorities. Family nurses have hospital admitting privileges and have the authority to prescribe many medications without a physician’s permission. In 17 states and Washington D.C., nurse practitioners have no limits in this area, which means that they may write prescriptions for narcotics and other controlled substances without a physician’s supervision. Furthermore, in more than twenty states, nurse practitioners are not obligated to practice under the authority of, or in collaboration with, a physician (although many, of course, still do).

Credentialing Organizations

Nurses specializing in family nursing must complete a lengthy and rigorous regimen of academic and clinical training, and must pass a series of formidable exams designed to assess their knowledge of both. Within the United States, the relevant professional certifications are granted by several organizations, including the American Nurses Credentialing Center and the American Academy of Nurse Practitioners. Before a nurse may apply for credentials, s/he must obtain a Bachelor of Science in Nursing (BSN) degree, through either a stand-alone program or as a waypoint in an academic curriculum that culminates in a graduate or doctoral degree.

State Licensing

Nurse Practitioners must also be licensed by the state in which they wish to practice. It’s important to understand that each of the fifty states has its own list of criteria prospective family nurse practitioners must fulfill. For example, some states don’t require nurses to have a graduate or doctoral degree in order to offer family nursing services; however, there is a strong trend in this direction, and by 2015 all – or almost all – of the states will only issue family nursing licenses to those holding the aforementioned advanced degrees.

Other Venues for Certified Nurse Practitioners

Family nursing isn’t confined to nurse-managed clinics. Nurse practitioners who specialize in family care are also frequently employed in hospitals, community clinics, convalescent/ nursing homes, hospices (for adults and children), educational institutions, home health care agencies and municipal medical offices. Schools are a tremendous environment for family nursing; school nurses must be able to switch gears quickly and often, assessing multiple patients one after the other, calling parents and interfacing with school administrators. Just as in private practice, a school nurse often has the opportunity to get to know an entire family, and provide care for growing children over four or five years. In this environment, the nurse must also be comfortable administering routine screenings for hearing loss, scoliosis, vision problems and head lice – especially in elementary schools. Furthermore, the nurse must be able to communicate clearly and effectively with individuals who come from a wide variety of cultural backgrounds and who may have unusual expectations regarding the role of the nurse in the care of their child(ren).

The Scope of Practice

Family nursing may also encompass:

  • *prenatal care and birth coaching
  • *immunizations and pediatric preventive care
  • *education for patients with chronic illnesses, such as diabetes
  • *providing school and sports physicals
  • *interpreting data from many types of lab tests, X-rays, CAT scans and other diagnostic tools
  • *assisting patients with basic illness prevention and health maintenance
  • *educating patients about contraception, safe sex and sexually transmitted diseases
  • *prescribing and evaluating physical and occupational therapy services

The Great Debate

Because in most states the precise dividing line between a certified nurse practicioner and a physician is growing increasingly fuzzy, some physicians have expressed concern that nurses may soon be expected to regularly handle cases for which they are not qualified. For example, many doctors acknowledge that a family nursing practitioner can assess, diagnose, treat and manage single-system disorders as well as a physician. However, they remain adamant that these nurses do not have the necessary knowledge and training to treat extremely complex cases involving multiple organ systems unless they do so under a superivising physician. This is a controversial debate that is unlikely to be resolved soon.

Holistic Care

What, then, sets family nurses apart? At this point, the answer to this question is more opinion than fact. The work of a Certified Nurse Practitioner has historically involved a much greater emphasis on preventative medicine and health maintenance than is expected from physicians. The scope of family nursing practice rarely involves simple, straight lines from diagnosis to treatment. To the contrary, nurses frequently approach problems from multiple angles, involving the patient’s family, community and entire environment surrounding the patient. Many certified nurse practitioners have a much more integrated, holistic approach to health care that stresses the importance of patient self-monitoring as an effective tactic for preventing health problems and diagnosing potentially serious illnesses at the earliest, most treatable stages.